Harvard Medical School Guide to Overcoming Thyroid Problems (Harvard Medical School Guides)

258 Pages·2005·2.04 MB·English

by  Jeffrey Garber, Sandra White

TH E
HARVARD M EDICAL
SCHOOL GUI DE TO
OVERCOM I NG
T HY R O I D P R O B L E M S
JEFFREY R. GARBER, M.D.
WITH SAN DRA SARDELLA WH ITE
Copyright © 2005 by the President and Fellows of Harvard College. All rights reserved. Manufactured
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Contents
Acknowledgments vii
Introduction ix
C H A P T E R 1 1
Your Thyroid Gland
How Your Thyroid Gland Works 1
When Things Go Wrong 4
Who Is at Risk for Thyroid Disease? 10
C H A P T E R 2 21
Life in the Slow Lane: Down and Under
with Hypothyroidism
Recognizing Signs and Symptoms 24
What Is Causing My Hypothyroidism? 30
Diagnosing Hypothyroidism 32
Treating Hypothyroidism 37
Thyroid Medications: Myths and Facts 47
C H A P T E R 3 51
Hyperthyroidism: Help, I Want to Slow Down!
Recognizing Signs and Symptoms 54
What’s Causing My Hyperthyroidism? 57
Diagnosing Hyperthyroidism 59
Treating Hyperthyroidism 61
Remembering What It’s Like to Feel Good 69
iii
CONTENTS
C H A P T E R 4 73
A Guide to Thyroid Tests
Blood Tests 73
Radioactive Iodine Tests 78
Thyroid Ultrasound 82
C H A P T E R 5 83
An Immune System Run Amok: Thyroiditis,
Graves’ Disease, and Related Problems
Your Immune System 84
Autoimmune Thyroid Disease 91
Graves’ Disease 97
Your Family Medical History 109
Lessons from One Woman’s Family History of
Thyroid-Related Conditions 112
C H A P T E R 6 117
Your Thyroid and Pregnancy
Your Thyroid and Infertility 118
From Infertility to Four Children: One Woman’s Success Story 119
Normal Hormone Changes During Pregnancy 122
Hypothyroidism During Pregnancy 123
Hyperthyroidism During Pregnancy 129
C H A P T E R 7 135
A Guide to Thyroid Lumps: The Harmless and
the Worrisome
Thyroid Lumps from A to Z 136
How Are Thyroid Nodules Diagnosed? 140
A Suspicious Nodule 151
Treatment Options 153
C H A P T E R 8 155
Thyroid Cancer
Why Me? 156
iv Who’s at Risk for Thyroid Cancer ? 158
CONTENTS
How Doctors Diagnose Thyroid Cancer 159
Treating Thyroid Cancer 165
Beating Thyroid Cancer 175
Folow-Up 178
Coping with Cancer 181
Staying Positive and Informed 182
C H A P T E R 9 185
Childhood Thyroid Diseases
Hypothyroidism in Children 186
Trusting Parental Instincts 197
Hyperthyroidism in Children 198
Nodules and Cancer 203
C H A P T E R 1 0 205
Negotiating Life with Thyroid Disease
You and Your Doctor 205
Taking Care of Yourself 210
C H A P T E R 1 1 215
Your Thyroid and Nuclear Radiation
Lessons from Nuclear Disasters 216
Protecting Your Thyroid Gland with Potassium Iodide 219
Glossary 225
Additional Resources 233
Index 237
v
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Acknowledgments
Throughout the creation of this book, from its inception through
its many drafts, production, and publication, many people helped
to enrich its pages.
I would like to especially thank Sandy White for her extraor-
dinary focus, timeliness, and wonderful writing. I am particularly
grateful for Sandy’s journalistic skill, which was the key to captur-
ing the experiences of patients and the views of experts that con-
tributed immensely to the value of our collaborative effort. I
would also like to thank editors Nancy Ferrari and Kathleen Cahill
Allison of Harvard Health Publications and Judith McCarthy of
McGraw-Hill for their invaluable assistance.
I also want to thank the many patients I have had the privilege
to participate in the care of, for the lessons they have taught me
about overcoming thyroid conditions. Special thanks to those who
graciously agreed to be interviewed for this book so that others
could also learn from their experiences.
I am in debt to many specialists who offered their expertise
without hesitation. Many thanks to Rebecca S. Bahn, M.D., of
the Mayo Clinic Endocrinology Division; Brian M. Casey, M.D.,
of the University of Texas Southwestern Medical Center Obstet-
rics and Gynecology Division; James Connolly, M.D., Kevin
Donohoe, M.D., Colin McArdle, M.D., J. Anthony Parker, M.D.,
Ph.D., and Helen H. Wang, M.D., Dr.P.H., colleagues in the Beth
Israel Deaconess Medical Center departments of anatomic pathol-
ogy, cytopathology, radiology, and nuclear medicine; John
Kukora, M.D., President of the American Association of Endo-
crine Surgeons; Stephanie Lee, M.D., Ph.D., and Elizabeth N. vii
Copyright © 2005 by the President and Fellows of Harvard College. Click here for terms of use.
ACKNOWLEDGMENTS
Pearce, M.D., M.Sc., colleagues in the endocrine divisions of
Harvard Vanguard Medical Associates and Boston Medical Cen-
ter; Marvin Mitchell, M.D., Emeritus Director of the New
England Newborn Screening Program; Yolanda Oertel, M.D., of
the Washington Hospital Center Washington Cancer Institute;
Steven I. Sherman, M.D., of the Department of Endocrine Neo-
plasia and Hormonal Disorders, M. D. Anderson Cancer Center.
I would like to thank William Kang and Jill Susarrey of Har-
vard Vanguard Medical Associates Endocrine Division for their
help with the countless tasks that led to the timely completion of
this book.
Thanks to my mother-in-law, Lillian, for her interest, and my
wife, Sheri, and sons, Ben and Solly, for their enthusiasm and
encouragement.
—JRG
I would like to thank Kay Cahill Allison, my mentor, and Jeff
Garber, for this incredible learning experience. It was a privilege
to work with a physician who is so well regarded by so many
patients. For her insights, I want to thank my close friend Carmen
Kenrich, who beat thyroid cancer. Thanks also to my daughters,
Samantha, Allyson, and Jessica, for their patience and to my hus-
band, Rob, for always encouraging me to go for it.
—SSW
viii